86 W 2nd St RES20-0130 Window Permit PacketOWNER:ADDRESS:CITY:STATE:ZIP:
BERRY ALICIA ET AL 2009 S WALL ST BELTON TX 76513
COMPANY:ADDRESS:CITY:STATE:ZIP:
THE HOME DEPOT 9208 Florida Palm Drive TAMPA FL 33619
TYPE OF
CONSTRUCTION:
REAL ESTATE
NUMBER:ZONING:BUILDING USE
GROUP:SUBDIVISION:
170837 0400 ATLANTIC BEACH SEC H
JOB ADDRESS:PERMIT TYPE:DESCRIPTION: VALUE OF WORK:
86 W 2ND ST RESIDENTIAL
WINDOWS/DOORS replace windows $1316.00
FEES
DESCRIPTION ACCOUNT QUANTITY PAID AMOUNT
BUILDING PERMIT 455-0000-322-1000 0 $60.00
BUILDING PLAN CHECK 455-0000-322-1001 0 $30.00
STATE DBPR SURCHARGE 455-0000-208-0700 0 $2.00
STATE DCA SURCHARGE 455-0000-208-0600 0 $2.00
TOTAL: $94.00
LIST OF CONDITIONS
Roll off container company must be on City approved list . Container cannot be placed on City right-of-way.
NOTICE: In addition to the requirements of this permit, there may be additional restrictions applicable to this property
that may be found in the public records of this county, and there may be additional permits required from other
governmental entities such as water management districts, state agencies, or federal agencies.
WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT
IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF
COMMENCEMENT MUST BE RECORDED AND POSTED ON THE JOB SITE BEFORE THE FIRST
INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN
ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT.
MUST CALL INSPECTION PHONE LINE (904) 247-5814 BY 4 PM FOR NEXT DAY INSPECTION.
ALL WORK MUST CONFORM TO THE CURRENT 6TH EDITION (2017) OF THE FLORIDA BUILDING
CODE, NEC, IPMC, AND CITY OF ATLANTIC BEACH CODE OF ORDINANCES .
ALL CONDITIONS OF PERMIT APPLY, PLEASE READ CAREFULLY.
1 of 2Issued Date: 6/9/2020
PERMIT NUMBER
RES20-0130
ISSUED: 6/9/2020
EXPIRES: 12/6/2020
RESIDENTIAL PERMIT
CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
2 of 2Issued Date: 6/9/2020
PERMIT NUMBER
RES20-0130
ISSUED: 6/9/2020
EXPIRES: 12/6/2020
RESIDENTIAL PERMIT
CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
DESCRIPTION ACCOUNT QTY PAID
PermitTRAK $98.00
RES20-0130 Address: 86 W 2ND ST APN: 170837 0400 $98.00
BUILDING $60.00
BUILDING PERMIT 455-0000-322-1000 0 $60.00
BUILDING PLAN REVIEW $30.00
BUILDING PLAN CHECK 455-0000-322-1001 0 $30.00
STATE SURCHARGES $8.00
STATE DBPR SURCHARGE 455-0000-208-0700 0 $2.00
STATE DCA SURCHARGE 455-0000-208-0600 0 $2.00
STATE DBPR SURCHARGE 455-0000-208-0700 0 $2.00
STATE DCA SURCHARGE 455-0000-208-0600 0 $2.00
TOTAL FEES PAID BY RECEIPT: R12086 $98.00
Printed: Tuesday, June 09, 2020 11:17 AM
Date Paid: Tuesday, June 09, 2020
Paid By: THE HOME DEPOT
Pay Method: CREDIT CARD 336103384
1 of 1
Cashier: CG
Cash Register Receipt
City of Atlantic Beach
Receipt Number
R12086
Building Permit App Hr ·,d on
City of Atlantic Beach Buildin g Department
800 Seminole Road, Atlantic Beach, FL 32233
Updated 10/9/18
**AllINFORMATION
HIGHLIGHTED IN GRAY
IS REQUIRED. Phone : (904) 247-5826 Fax: (904) 247-5845 Email: Building-Oept@coab.us
Job Address: $-~ ~ J V\ ~ s+-Permit Number: ___________ _
Legal Descri ption I ~ -c3 '-1-17· .2S ~ ~ t;,. fj':>-7 [~+ X~ ~\o....\"o~\.~ ~~~"'RE# I 7 () ~ J ., ~ ~ ~ \ \)
0((. II },3 <j'V
Valuation of Work (Replacement Cost) $_t ... )"-,I,-~,,,,---____ Heated/Cooled SF Non-Heated/Cooled _____ _
• Class of Work: ~ DAddition~eration DRepair DMove DDemo DPool DWindow/Door
• Use of existing/proposed structure(s): JC?j:ommercial ~esidential
• If an existing structure, is a fire sprinkler system installed?: I2JYes DNo
• Will tree s be removed in association with ro osed s must submit se
Describe in detail the type of work to be performed:
R~\<\~ ~ W\.AU\J'I'>-~\2.L ~Sl.~
Florida Product Approval #-.+-I_"+-I q--+->I...I..I_' \{..>.-______________ for multiple products use product approval form
Address S w ~ V\.C 4-
Property Owner Information
Name '1\\ I.IU.'e>.. ~"i>'j
City ?-+\~'h\'<:...-~cIA State pe-Zip.3 ;)..~>2 Phone 99 y 'X$~~ 1~r'J ¥
E-Mail _______________________ ~--------------------
Owner or Agent (If Agent, Power of Attorney or Agency Letter Required) _n_/a __________________ ___
Contractor Information
Name ofCOmpany~\;.\\~.w.>L~,)~\-Qualifying Agent (.\M~ ~V\..~u
Address ~~ ~ ELIK':~_.Ko..~ ,\), City~""tF.0. State fL.-Zip ,):)(...\ 9
Office Phone 1..l7-':f (,;z -:a '-.I.. \{ Ie;, Job Site Contact Number _______________ _
State Certification/Registration # Cc:e./C'J ~ \ ''{ I E-Mail ______________________ _
Architect Name & Phone # ___________________________________ _
Engineer's Name & Phone # __________________________________ ___
Workers Compensation Insurer OR Exempt 0 Expiration Date _______ _
Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work or installation has
commenced prior to the issuance of a permit and that all work will be performed to meet the standards of all the laws regulating
construction in this jurisdiction. I understand that a separate permit must be secured for ELECTRICAL WORK, PLUMBING, SIGNS,
WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS, and AIR CONDITIONERS, etc. NOTICE : In addition to the requ irements of this
permit, there may be additional restrictions applicable to this property that may be found in the public records of this county, and
there may be additional permits required from other governmental entities such as water management districts, state agencies, or
federal agencies .
OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all
applicable laws regulating construction and zoning.
WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY
RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND
TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE
RE G YOUR NOTICE OF COMMENCEMENT.
ignature of Owner or Agent)
t ,(.t.t=.:..,P,:'f:.:.~.,.,. t-;otary Pub li c - State of Fl or id a
• . ., COMmission" GG • 97408
[ 1 Personally Known OR \~~;?if...~'5i My ComM. Exp ires \\ar 18.2022
...... Bo nd ed through National \';ota ry Assn. t4 pro~uced I~e ntification 1.._"";;;';;;';'~"'----"'
Signed and sworn to (or affi med) before me this J / day of
/I1-c ... g ,~<=?--, by /-!;../4/J /" Iv. Mhc:L/
0'Personally Known OR
[ 1 Produced Identification
L~
:?' (Signature of Notary)
~'\~RY 04 r Aaron Hallich ~ NOTARY PUBLIC
§ . . ~STATE OF FLORID A ~;.,.: .~ Comm# GG951577
1NCE ,g,'O Expires 1/27/202 4
" PRODUCT APPROVAL INFORMATION SHEET FOR THE CITY OF ATLANTIC BEACH, FLORIDA (*REQUIRED)
_____________________________________________________________________ permit#: ________________________ __
*Owne~ProjectName: ______________________________________________________________________________________________ ___
As required by Florida Statute 553.842 and Florida Administrative Code Rule 98-72, please provide the information and product approval number(s) for
the building components listed below as applicable to the building construction project for the permit number listed above. You should contact your
product supplier if you do not know the product approval number for any of the applicable listed products. Information regarding statewide product
approval may be obtained at: www.floridabuilding.org .
Category/Subcategory Manufacturer Product Description Limitation of Use State # Local #
I A. EXTERIOR DOORS
1. Swinging
2. Sliding
3. Sectional
4. Garage Roll-Up
5. Automatic
6. Other
B. WINDOWS
1. Single hung S \ u ,~ l, II'--R. ,0 ,yCYl/~~
2. Horizontal slider
3. Casement
4. Double hung
5. Fixed
6. Awning
7. Pass -through
8. Projected
9. Mullion
10. Wind breaker
11 . Dual action
12. Other
Page 1 of 4 Uodated 10/1 7/1 8
(0 q~'{(j~/
:,'1 addition to completing the above list of manufacturers, product description and State approval number for the products used on this project, the
Contractor shall maintain on the job site and available to the Inspector, a legible copy of each manufacturer's printed specifications and installation
instructions along with this Product Approval Sheet.
I certify that this product approval list is true and correct to the best of my knowledge . I further certify that use of different components other than the
ones listed in this document must be approved by the Building Official.
'Contractor Name (Print Name): Arthur Francis 'Contractor Signature: ~fi
*Company Name: The Home Depot
*Mailing Addres s: 9208 Florida Palm Dr
*City: Tampa *State: FL *Zip Code : 33619 --------------------------
*Telephone Number: (727) 637-8400 *E-mail Address : tim.omalley@expeditepermit.com
Ce ll Phone Number: Fa x Number: __________________________ __
Page 4 of 4 Upda t ed 10, '17/18
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